WO2000076432A1

WO2000076432A1 - Clip and applicator for tubal ligation

Info

Publication number: WO2000076432A1
Application number: PCT/CA2000/000683
Authority: WO
Inventors: Mark Stafford Carey
Original assignee: Mark Stafford Carey
Priority date: 1999-06-10
Filing date: 2000-06-09
Publication date: 2000-12-21
Also published as: AU5380200A

Abstract

A clip and applicator for clamping a fallopian tube, and a method of carrying out the procedure. The clip has pivoting jaws which are adapted to pivot between a first open position where the jaws are apart, a second substantially closed position, and a third closed and locked position. The clip has means to bias the jaws towards the open position. Complementary locking means at the forward end of each jaw secure and lock the clip. The applicator comprises an elongate body over which a sleeve axially slides. The sleeve is adapted to move the jaws into the substantially closed position for insertion of the clip through the incision, and then to the closed and locked position to occlude the fallopian tube. The clip is removably attached to the applicator by docking means adapted to secure the forward end of the applicator body to the rear end of the clip.

Description

Title: CLIP AND APPLICATOR FOR TUBAL LIGATION

BACKGROUND OF THE INVENTION

Field of the Invention

This invention relates to a clip and laparoscopic clip applicator for tubal ligation,

and a method of performing the procedure. In particular, the invention relates

to a small profile clip to be inserted through a small incision in the abdominal

cavity of a patient in order to occlude the fallopian tubes, and to a method of

performing the procedure using the device.

Tubal ligation is a safe, effective, and common means of contraception for

women. The operation is now usually performed endoscopically using a small

rigid laparoscope which is a viewing device containing a light source and a

camera. A ligation clip and applicator or cautery device designed to occlude

the patient's fallopian tubes is used. Laparoscopic instruments are designed

to be inserted into the operative field through small incisions in the wall of the

abdomen. The operation may also be performed without the aid of an

endoscope by making a larger incision in a procedure commonly referred to as minilaparotomy. In both procedures, the patient's fallopian tubes are closed

using clips which are clamped in place using an applicator.

The prevalence of minimally invasive surgery has found applications in many

realms of surgical practice. In the case of tubal ligation, laparoscopic

sterilization has increased and minilaparotomy has decreased.

Laparoscopic sterilization results in a shorter less painful procedure and

decreased use of health care resources. However, some pain and nausea still

accompany the procedure. Recent studies have suggested that performing the

procedure under local anesthesia has medical benefits including avoiding the

costs and risks associated with a general anaesthetic. It also leads to a

quicker recovery time and less time spent in the hospital.

Importantly, known clips and applicators are not designed specifically to be

used with local anaesthetic due to their larger size .

Description of the Prior Art

Examples of prior art include Hulka et al. (US Patent No. 3,882,854) and Casey

etal. (US Patent No. 4,489,725). Hulka et al. (US Patent No. 3,882,854) discloses a surgical clip and applicator.

The clip is hinged around a stainless steel pin and is held open by a U-shaped

spring. When the target fallopian tube is positioned between the jaws of the

clip, the same spring is pushed over the top and bottom jaws of the clip by the

applicator to secure the clamp in the closed position. The clip applicator is a

laparoscopic instrument adapted to receive the clip.

Casey et al. (US Patent No. 4,489,725) discloses a surgical clip with two jaws

hinged by lugs extending from the upper jaw mating with corresponding

apertures in the lower jaw. The clip is closed by pressure from the applicator

which deforms the upper jaw causing it to lengthen and abut against a latching

portion of the lower jaw.

In the last several years, manufacturers have been able to miniaturize

endoscopic lenses for insertion into the abdomen through an incision no larger

than 2 - 4 mm in size. The prior art clips are too large to fit through such an

incision. Accordingly, there is a need for smaller clips and applicators

specifically designed for local anesthesia to realize the benefits of this type of

procedure. In addition, there is a small but significant failure rate for the prior art clips. The

most common reason for the failures is misapplication. Accordingly, there is

also a need for a method and an applicator which can reduce the potential for

operator error.

SUMMARY OF THE INVENTION

It is an object of the invention to provide an improved clip and applicator and a

method of performing a tubal ligation procedure using the clip and applicator.

The improved clip and applicator according to the invention can be cost-

effectively manufactured in a size small enough to fit through an incision 5 mm

or smaller, allowing it to take advantage of the new miniature endoscopic

lenses and making it particularly suitable for outpatient procedures performed

under local anesthesia. This allows the patient to experience the benefits of a

tubal ligation performed under local anesthesia, as well as reducing the use of

costly hospital resources.

Furthermore, the device and method according to the invention provides an

improved locking mechanism for the clip to reduce the potential for operator

error and reduce the risk of incomplete fallopian tube occlusion. The present invention relates to a clip and applicator for clamping a fallopian

tube. The clip and applicator have complementary docking means for

removably attaching one to the other.

The clip, which has a forward end and a rear end, comprises an upper jaw and

a lower jaw body. The upper jaw and the lower jaw body each have a forward

end and a rear end. The jaws are pivotally attached by means of a hinge and

are adapted to pivot between a first open position where the jaws are apart, a

second substantially closed position to minimize the profile or cross section of

the clip for insertion through a small incision, and a third locked position where

the jaws are pressed together to close the fallopian tube. Biasing means

cooperate with the hinge to bias the jaws to the open position, specifically by

means of upwardly locating and biasing the upper jaw with reference to the

lower jaw body. Complementary locking means at the forward ends of the

upper jaw and lower jaw body operate to lock the clip in the third closed and

locked position.

The applicator comprises an elongate body over which a sleeve axially slides.

The sleeve covers a rear section of the lower jaw when the clip is in the open

position. The sleeve is adapted to push the jaws into the substantially closed

position for insertion of the clip through the incision. The sleeve is also

configured to push the jaws into the closed positions and lock the jaws in the closed position by engaging the locking means thereby occluding the fallopian

tube. Preferably, two slots are defined within the front end of the sleeve to

accommodate the fallopian tube as the sleeve operates to close and lock the

clip.

The invention also provides a method of closing a fallopian tube comprising the

steps of:

(a) attaching the applicator to a clip;

(b) positioning the jaws of the clip in the substantially closed position

(c) inserting the clip in the substantially closed position into the

abdominal cavity through an incision;

(d) releasing the jaws of the clip in the open position when the clip is

inside the abdominal cavity;

(e) positioning the clip such that the fallopian tube is located between

the jaws of the clip;

(f) locking the jaws of the clip to clamp the fallopian tube;

(g) releasing the locked clip from the applicator; and

(h) withdrawing the applicator.

Further features of the invention will be described or will become apparent in

the course of the following detailed description. BRIEF DESCRIPTION OF THE DRAWINGS

In order that the invention may be more clearly understood, a preferred

embodiment thereof will now be described in detail by way of example, with

reference to the accompanying drawings, in which:

Figure 1 A is an isometric view of the clip.

Figure 1 B is an isometric view of the clip from a direction opposite to

Figure 1A.

Figure 1C is an isometric view of the clip showing the front end of the clip in cross section.

Figure 2 is a cross sectional view of the applicator and clip.

Figure 3 is another cross sectional view of the applicator and clip showing the clip in a closed position.

Figure 4 is another cross section view of the applicator and clip showing the clip in a locked position.

Figure 5 is a view partly in section showing the applicator ready to be attached to the clip.

Figure 6 is a view partly in section showing the clip inserted into the applicator and being rotated. Figure 7 is a view partly in section showing the clip secured within the applicator.

Figure 8 is an isometric view of the clip and applicator at the commencement of the closing sequence.

Figure 9 is an isometric view of the clip with the faceplate removed and the applicator showing the clip in the substantially closed position.

Figure 10 is an isometric view of the clip with the faceplate removed and the applicator showing the clip in the closed and locked position.

Figure 11 is a view partly in section of the underside of the concentric sleeve showing the key.

PREFERRED EMBODIMENT

To better describe the invention, the terms up, down, front and rear will be

used with reference to the clip. These directions are used as guides with

reference to the orientation of the clip as shown in Figure 1C.

Referring to Figures 1A and 1 B, the clip 20 is comprised of an upper jaw 1

and a lower jaw body 3. The upper jaw 1 attaches to the lower jaw body 3 by

means of a hinge 2. A suitable biasing means is provided to cooperate with the hinge to upwardly bias the upper jaw 1 such that the clip 20 always tends

to and remains in an open position. In the open position the clip 20 has a jaw

like profile.

The hinge 2 is comprised of a pin member 4 which fits through corresponding

apertures at the rear end of the upper jaw 1 and lower jaw body 3

respectively. Preferably, the pin 4 is made of titanium. The pin is orientated

transversely and fixedly secured within the corresponding apertures of the

lower jaw body by means of crimping the pin. The upper jaw, which is

pivotally secured to the lower jaw body by the pin, is able open and close with

reference to the lower jaw body 3. The ends of the pin are flush with the

lower jaw body of the clip such that the clip may be safely inserted into and

guided through the abdominal cavity.

The biasing means used to upwardly bias the upper jaw (not shown in

figures) may be selected from at least two options. A resilient spring element

located inside of the intersection of the upper jaw 1 and lower jaw body 3 may

be used. The resilient spring element may comprise, for example, an

integrally formed resilient arm extending diagonally upwards from the top

surface of the lower jaw body abutting the bottom surface of the upper jaw.

Alternatively, the means for upwardly biasing the upper jaw may comprise some other resilient material located inside the intersection of the upper jaw 1

and lower jaw body 3, as for example, silicon.

To close the upper jaw 1 , a downward force must be applied which is greater

than the upward force exerted by the upward biasing means. The biasing

means tends to force the upper jaw into the open position when the

downward force is removed. Substantial closure of the clip to minimize its

profile is necessary for insertion of the clip into the abdominal cavity through a

small incision. After insertion, the clip must be able to open inside the

abdominal cavity. The operation of the clip is described in greater detail later

in the specification.

The outer surface of the lower jaw body 3 is generally smooth and rounded.

The top surface of the upper jaw 1 , which is preferably made of titanium, is

flat. Each of the upper jaw 1 and lower jaw body 3 have interior opposing

clamping surfaces 16A and 16B respectively which are generally flat and

approximately 4 mm by 10 mm in dimension. During operation of the clip it is

the interior clamping surfaces which occlude the fallopian tube.

Referring now to Figures 1A and 1C, the clip 20 has complementary locking

means formed integrally adjacent its open ends which function to close and

lock the upper jaw 1 with reference to the lower jaw body 3 in a manner described hereinafter. As well, the clip has docking means 12 at its rear for

engagement with and removable attachment to an applicator used to

manipulate and install the clip as hereinafter described.

The complementary locking means consist firstly of a downwardly extending

locking element 4 formed integrally and located at the front end of upper jaw

1. Secondly, the locking means consist of a receiving member 6 forming a

cavity located at the front end of the lower jaw body 3 and formed integrally

therewith which receives the locking element to retain it within thereby locking

the upper jaw with reference to the lower jaw body. Figure 1 C, which is a

cross sectional view of the front end of the clip, shows the locking element 4

within the receiving member 6.

Referring to Figure 1A and in particular to Figure 1C, the locking element 4 is

located at the extreme forward end of the upper jaw 1 and extends

downwardly at substantially 90 degrees with reference to the upper jaw. The

locking element terminates at a sharp point 17 and is further comprised of two

outward protrusions18 located above the sharp point, one on each side

thereof. The sharp point aids in the closure and subsequent locking of the

clip by piercing a membrane attached to the fallopian tube. Each protrusion 18 has an engagement surface and a locking surface. The

engagement surface of each protrusion curves gently at its base and the

outside edge is tapered inwardly. The inward tapering of the protrusions

facilitates the insertion of the locking element 4 into the receiving member 6

and is described in greater detail later in the specification. The locking

surface of each protrusion 18 is located at the top edge thereof and is

outwardly perpendicular with reference to the body portion of the locking

element 4. The locking surfaces abut the receiving member 6 to prevent the

egress of the locking element 4 from the receiving member when the clip is in

the closed and locked position, which is hereinafter described.

Referring still to Figures 1A and 1 C, the receiving member 6 is comprised of a

faceplate 19 (removed in Figure 1C) located at the extreme front end of the

lower jaw body and two sets of bars, an upper set of locking bars 22 and a

lower set of supporting bars 23, which connect the faceplate to the lower jaw

body 3. Each set of bars function to provide support and rigidity to the front

end of the clip, and in particular to the receiving member. The locking bars 22

perform an additional function. Specifically, the upper set of locking bars

cooperate and engage with the protrusions 18 of the locking element 4 to lock

the clip in the closed and locked position. Each locking bar has an

engagement surface and a locking surface. The engagement surface of each locking bar, located on the inside surface thereof, is tapered inwardly at an

angle corresponding to the outer tapered edges of the protrusions.

During ligation of the fallopian tube, the locking element 4 is forced into

contact with the receiving member 6. More specifically, the engagement

surface of each protrusion 18 comes into contact with the engagement

surface of a corresponding resilient locking bar 22. The maximum width of

the locking element, to be taken as the distance between the outer most edge

of each protrusion, is greater than the width of the space separating the upper

locking bars. Therefore, as a greater downward force is applied to the upper

jaw 1 , each protrusion 18 simultaneously exerts a greater outward force on its

corresponding locking bar 22. The locking bars are flexed outwardly and

spread apart in response to the outward force. The flexing of each locking

bar is aided by the curved base and tapered outside edge of each protrusion,

permitting the protrusions to slide downwardly over the locking bars. Once

each protrusion has slid completely over and past its corresponding locking

bar, the outward force is no longer exerted. Each resilient locking bar then

automatically returns to its original unflexed configuration. The flat locking

surface of the protrusions prevent the egress of the locking element as each

protrusion catches and abuts against the locking surface of the locking bar it

engages. This operation describes the means by which the upper jaw is

locked to and secured to the lower jaw body of the clip. Referring to Figure 1 B, the docking means consist of a cam like docking tab

12 attached to the end of the clip by means of stem 14.

Referring to Figures 1 B and 2, the docking means further include anti-rotation

means located on the underside of the lower jaw body 3 of the clip which

engage complementary means on the applicator. The anti-rotation means on

the clip comprises a keyway 13 which is open at the rear as shown. The

keyway 13 extends longitudinally along the underside of the lower jaw body

ending with a stop 25 short of front end of the lower jaw body as better shown

in Figure 4. The function of the keyway will be later described.

The applicator is now described. The purpose of the applicator is to hold and

permit the clip to be manipulated by the surgeon during the tubal ligation

procedure.

Referring to Figures 2, 3 and 4, the operation of the applicator is described

with respect to the clip. The applicator comprises a cylindrical core body 40

and a telescoping concentric sleeve 10 external to the core body 40. The

forward end of core body 40 has receiving means for the docking tab 12 and

the telescoping sleeve 10 which when operated moves forwardly to close and

lock the clip around a fallopian tube. Referring now to Figures 5, 6 and 7, the applicator body 40 is hollow at its

front end defining a cavity. An end plate 41 is provided having an aperture 11

which communicates with the cavity. The shape of the aperture corresponds

to the shape of the docking tab 12. Thus the clip may be attached to and

secured within the applicator by means of insertion of the docking tab into the

aperture and rotation of the applicator body and end plate attached thereto

with reference to the clip an angular distance with sufficient to wedge and

secure the docking tab behind the end plate in the cavity.

Referring to Figures 8, 9 and 10, the telescoping concentric sleeve 10 has jaw

like cut out side openings 15 on each side corresponding in length to the

length of the clamping surfaces of the clip when attached to the applicator as

described. Referring to Figure 11 , the telescoping concentric sleeve 10 also

has a longitudinal key 50 located on the interior of the bottom sleeve which

aligns with and engages keyway 13 of the clip (shown in Figures 1 B and 2) to

prevent the rotation of the clip within and with reference to the applicator.

The telescoping concentric sleeve accordingly can be moved forwardly and

rearwardly relative to the forward end of the core body as described

hereinafter.

The tubal ligation method using the clip and applicator is now described. Referring to Figures 5, 6 and 7, the clip 20 is attached to and retained within

the cylindrical core body 40 of the applicator by insertion of the docking tab 12

into the aperture 11 on the cylindrical core body 40 which is rotated an

angular distance of 180 degrees with reference to the clip. This action

wedges and secures the cam like docking tab behind the end plate 41 and

prevents longitudinal separation of the clip from the applicator. Thus, the clip

is functionally and removably attached to the applicator and is aligned so that

the key 50 on the applicator is in a position to engage and slide into the

keyway 13 of the clip.

Referring to Figures 2 and 8, the telescoping concentric sleeve 10 is moved

forwardly over the clip. This step engages the key 50 within the keyway 13

located on the underside of the clip, and prevents any rotation of the clip with

reference to the applicator body. At this stage the clip is in the open position

and has a jaw like profile. The upper jaw 1 and lower jaw body 3, specifically

the clamping surface of each, are substantially apart.

Referring now to Figure 3, the forward movement of the concentric sleeve

now depresses downwardly the upper jaw 1 over the lower jaw body 3 of the

clip. This motion forces the upper jaw towards the lower jaw body. When the

locking element 4 comes into contact with the receiving member 6, the surgeon receives a tactile sensation, as the telescoping concentric sleeve no

longer slides easily over the clip. As described above, in order to lock the

clip, a pre-determined downward force must be exerted to overcome the

resistance provided by the locking bars 22. The tactile sensation of the

engagement surface of each protrusion 18 engaging its corresponding locking

bar indicates that the clip is in the substantially closed position for the purpose

of insertion into the abdominal cavity. A tactile indication that the clip is in the

substantially closed position also assists in ensuring that the surgeon does

not accidentally lock the clip, which operation is hereinafter described. It is

important to note that this closed orientation of the clip presents a minimum

forward profile or cross section, which is one of the important objects of the

invention.

Additionally, tactile feedback to the surgeon may be provided by means of an

abutment 26 located on the top surface of the upper jaw 1. Contact of the

front edge of the telescoping concentric sleeve 10 with the abutment 26

provides the surgeon with a tactile indication that the clip is in the

substantially closed position. An abutment provides a redundancy or

additional tactile indication that the clip is in the closed position to ensure that

the surgeon does not accidentally lock the clip. In the substantially closed position, as illustrated in Figure 3, the forward

profile or cross section of the clip 20 is minimized permitting insertion of the

clip and applicator which is attached thereto into the patient's abdominal

cavity through a small incision. No attempt is made here to describe any

particular surgical technique or procedure which a particular surgeon would

use. Rather the physical features of the applicator and clip and its operation

are sought to be described.

When the substantially closed clip has been inserted into the patient's

abdominal cavity, the surgeon, with the aid of a laparoscopic device, retracts

the telescoping concentric sleeve 10 which action permits the upper jaw 1 to

return to its preferred biased open position described above and shown in

Figures 2 and 8. The surgeon then positions the clip such that the targeted

fallopian tube (not shown) is positioned between the inner clamping surfaces

16A and 16B.

After the operator has positioned the targeted fallopian tube (not shown)

between the clamping surfaces 16A and 16B, the telescoping concentric

sleeve 10 is again moved forwardly over the upper jaw 1 and lower jaw body

3 of the clip. Once again, the surgeon receives the tactile sensation of the

locking element coming into contact with the receiving member, or sleeve 10

coming into contact with abutment 26, prior to locking the clip as described hereinafter. The side openings 15 on the telescoping concentric sleeves 10

provide clearance for the fallopian tube.

Referring to Figures 3 and 4, and also 9 and 10, the surgeon now moves the

telescoping concentric sleeve 10 forwardly, overcoming the resistance

provided by the locking bars and until the key 50 abuts against stop 25

located on the underside of the lower jaw body 3 of the clip. Figure 9 shows

the locking element within the receiving member, and specifically the locking

bars being forced outwards in response to the downward force applied to the

upper jaw. The leading edge of the telescoping concentric sleeve continues

to advance in a forward direction out over and past the locking element. As a

consequence, the locking element moves downwardly such that the

protrusions pass completely through the locking bars and such that the

locking surface of each protrusion engages the locking surface of its

corresponding locking bar as described in detail earlier in the specification,

and shown in Figures 4 and 10. This operation locks the upper jaw with

reference to the lower jaw body of the clip. The clip is now in a closed and

locked position and the fallopian tube is occluded.

The clip 20 may now be disengaged from the applicator by rotating the core

body 40 through an angular distance of 180 degrees in the opposite direction

such that the docking tab and aperture are once again in alignment, while holding the clip secure within the concentric sleeve 10 by means of the

keyway 13. This operation releases the docking means and permits the

applicator to be directly withdrawn from the abdominal cavity leaving the clip

attached to and occluding the fallopian tube.

From the foregoing, it will be seen that this invention is one well adapted to

attain all the ends and objects hereinabove set forth together with other

advantages which are obvious and which are inherent to the structure.

It will be understood that certain features and subcombinations are of utility

and may be employed without reference to other features and

subcombinations. This is contemplated by and is within the scope of the

claims.

Since many possible embodiments may be made of the invention without

departing from the scope thereof, it is to be understood that all matter herein

set forth or shown in the accompanying drawings is to be interpreted as

illustrative and not in a limiting sense.

Claims

CLAIMSHaving described the invention, what is claimed is:

1. A clip and applicator for clamping a fallopian tube:

(a) said clip and said applicator having complementary docking

means for removably attaching one to the other;

(b) said clip having a forward end and a rear end, said clip

comprising:

(i) a lower jaw body having a forward end and a rear end;

(ii) an upper jaw having a forward end and a rear end;

(iii) a hinge connecting said upper jaw to said lower jaw body;

said upper jaw adapted to pivot between a first open

position where said jaws are substantially apart, a second

substantially closed position where said jaws are closed

but not locked for insertion of the clip through an incision,

and a third closed and locked position;

(iv) biasing means attached to said lower jaw body to upwardly

locate and bias the upper jaw with reference to the lower

jaw body to said first open position;

(v) complementary locking means located at the forward ends

of said upper jaw and said lower jaw body, operable to close and lock said upper jaw in said third closed and

locked position;

(c) said applicator comprising:

(i) an elongate body having a forward end;

(ii) a sleeve on said elongate body operable to slide to engage

and move said upper jaw of said removably attached clip

to said first, second and third positions.

2. The invention as claimed in Claim 1 , wherein said complementary

locking means comprises: a locking member on one said forward end

consisting of a projection, said projection having an engaging surface at

the leading edge thereof and a locking surface rearward of said

engaging surface; and a receiving member on the other said forward

end consisting of a laterally resilient bar having an engaging surface

and locking surface; said engaging surface of said projection operating

to spreadingly engage said engaging surface of said resilient bar to

abut said locking surface on said projection against said locking surface

on said resilient bar thereby locking said locking member within said

receiving member.

3. The invention as claimed in Claim 2, wherein said hinge consists of pin

means connecting said rear end of said upper jaw to said lower jaw

body.

4. The invention as claimed in Claim 3, wherein said pin means is made

of titanium.

5. The invention as claimed in Claim 4, wherein said biasing means

comprises a quantity of resilient material attached to said lower jaw

body compressible in response to downward pivoting movement of said

upper jaw.

6. The invention as claimed in Claim 5, wherein said resilient material is

silicon.

7. The invention as claimed in Claim 4, wherein said biasing means is a

spring element attached to said lower jaw body compressible in

response to downward pivoting movement of said upper jaw.

8. The invention as claimed in Claim 7, wherein said spring element is a

resilient arm.

9. The invention as claimed in Claim 6 or 8, wherein said clip further

comprises an outer surface, said outer surface defining an abutment,

said abutment configured to position said sleeve in said substantially

closed position.

10. The invention as claimed in Claim 9, wherein said upper jaw is made of

titanium.

11. The invention as claimed in Claim 10, wherein said lower jaw body is

made from a plastic polypropylene material.

12. The invention as claimed in Claim 11 , wherein said complementary

docking means comprises: a cavity within said forward end of said

applicator body bounded by an end plate having a shaped aperture

therein; and a corresponding shaped projection attached to said rear

end of said lower jaw body of said clip; said clip being removably

attachable to said applicator by means of insertion of said projection

into said aperture and rotation thereof.

13. The invention as claimed in Claim 12, wherein said projection is a cam.

14. The invention as claimed in Claim 13, wherein said complementary

docking means further includes complementary anti-rotation means

consisting of means attached to said sleeve for engagement with

complementary means on said clip to prevent rotation of said clip with

reference to said applicator.

15. The invention as claimed in Claim 14, wherein said anti-rotation means

comprises: key means attached to said sleeve; a key way formed in

said lower jaw body; said key means engaging said key way to permit

axial movement of said sleeve with reference to said clip while

preventing rotational movement of said applicator body with reference

to said clip.

16. The invention as claimed in Claim 15, wherein said sleeve further

comprises an inner surface and an outer surface, and said key means comprises a rail projecting inwardly from said inner surface of said

sleeve.

17. The invention as claimed in Claim 16, wherein said key way comprises

a channel formed in said bottom surface of said lower jaw body.

18. The invention as claimed in Claim 17, wherein said rail is configured to

slidably engage said channel to prevent the rotation of said clip relative

to said applicator when said clip is attached to said applicator.

19. The invention as claimed in Claim 18, wherein said channel terminates

at a stop near said front end of said clip, said stop configured to prevent

further forward movement of said sleeve when said clip is in said

closed and locked position.

20. A method of closing a fallopian tube in an abdominal cavity of a patient

with a clip, the clip having two pivotally connected jaws biased in an

open position, the jaws configured to pivot between the open position, a

substantially closed position, and a locked closed position, the method

comprising the steps of:

(a) removably attaching an applicator to a clip;

(b) positioning the jaws of the clip in the substantially closed position;

(c) inserting the clip attached to the applicator through an incision

made in the abdominal cavity, the clip being positioned in the

substantially closed position; (d) releasing the jaws of the clip into the open position when the clip

is inside the abdominal cavity;

(e) positioning the clip such that the fallopian tube is located

between the jaws of the clip;

(f) locking the jaws of the clip to clamp the fallopian tube;

(g) releasing the locked clip from the applicator; and

(h) withdrawing the applicator.

21. A method of clamping a fallopian tube as defined in Claim 22 further

comprising the step of inserting an endoscopic camera into the incision

to assist the operator in locating the clip and carrying out the method.

22. A method of clamping a fallopian tube as defined in Claim 23, wherein

the applicator further comprises a body axially slidable within a sleeve.

23. A method of clamping a fallopian tube as defined in Claim 24, wherein

the clip is secured within the applicator in the substantially closed

position by sliding the sleeve forward over the jaws of the clip to move

them into the substantially closed position.

24. A method of clamping a fallopian tube as defined in Claim 25, wherein

the clip is released into the open position by pushing the clip attached

to the body, causing the sleeve to slide backward along the clip

allowing the jaws to be released into the open position.

5. A method of clamping a fallopian tube as defined in Claim 26, wherein

the clip is locked by sliding the sleeve forward over the jaws of the clip

to move them into the locked position.